U.S. patent application number 13/079173 was filed with the patent office on 2011-10-27 for system and method for remotely diagnosing and managing treatment of restrictive and obstructive lung disease and cardiopulmonary disorders.
This patent application is currently assigned to ENGINEERED VIGILANCE, LLC. Invention is credited to Stephen B. CORN.
Application Number | 20110263997 13/079173 |
Document ID | / |
Family ID | 44816380 |
Filed Date | 2011-10-27 |
United States Patent
Application |
20110263997 |
Kind Code |
A1 |
CORN; Stephen B. |
October 27, 2011 |
SYSTEM AND METHOD FOR REMOTELY DIAGNOSING AND MANAGING TREATMENT OF
RESTRICTIVE AND OBSTRUCTIVE LUNG DISEASE AND CARDIOPULMONARY
DISORDERS
Abstract
An apparatus, system and method for non-contact monitoring of
respiratory functions that is used to identify and treat
restrictive and obstructive lung disease or cardiopulmonary
disorders including asthma or congestive heart failure in a
monitored subject from a remote location. Respiratory waveforms are
generated based on non-contact monitoring of physiologic functions.
The generated waveforms are analyzed and compared to waveforms to
help identify the presence of cardiopulmonary disease.
Inspiratory:Expiratory ratios (I:E ratios) are calculated from the
generated waveform to assist remote clinicians in their diagnosis
and treatment of the monitored subject.
Inventors: |
CORN; Stephen B.; (Sharon,
MA) |
Assignee: |
ENGINEERED VIGILANCE, LLC
Sharon
MA
|
Family ID: |
44816380 |
Appl. No.: |
13/079173 |
Filed: |
April 4, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11308675 |
Apr 20, 2006 |
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13079173 |
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61320561 |
Apr 2, 2010 |
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Current U.S.
Class: |
600/529 |
Current CPC
Class: |
A61B 8/08 20130101; G01S
15/88 20130101; A61B 5/0816 20130101; A61B 2503/06 20130101; G01S
17/50 20130101; A61B 5/1114 20130101; A61B 5/486 20130101; A61B
8/4472 20130101; A61B 5/08 20130101; A61B 5/113 20130101; G01S
17/88 20130101; G01S 15/50 20130101 |
Class at
Publication: |
600/529 |
International
Class: |
A61B 5/08 20060101
A61B005/08 |
Claims
1. A monitoring and analysis system for identifying and treating
restrictive and obstructive lung disease or cardiopulmonary
disorders from a remote location, comprising: a respiratory
waveform detection module, the respiratory waveform detection
module performing non-contact monitoring of a subject to detect
respiratory motion and generating a waveform based on the detected
respiratory motion; an analysis module programmatically analyzing
the generated waveform to identify restrictive and obstructive lung
disease or cardiopulmonary disorders in the monitored subject, the
analyzing calculating an inspiratory:expiratory (I:E) ratio from
the generated waveform and comparing the generated waveform to a
stored waveform indicative of restrictive and obstructive lung
disease or cardiopulmonary disorders, a result of the comparison
and the I:E ratio displayed to a remotely located clinician.
2. The system of claim 1 wherein the respiratory waveform detection
module and the analysis module communicate over a network.
3. The system of claim 1 wherein the analysis further compares the
generated waveform to a stored waveform of the subject captured
during a previous monitoring period.
4. The system of claim 1 in which the I:E ratio is calculated as a
quotient of a duration of time that a target surface is moving away
from a sensor and a duration of time the target is moving towards
the sensor.
5. The system of claim 1 wherein the respiratory waveform detection
module monitors the subject using radiated energy.
6. The system of claim 5 wherein the respiratory waveform detection
module monitors the subject using ultrasound.
7. The system of claim 5 wherein the respiratory waveform detection
module monitors the subject using one of laser detection, infrared
or radio frequency transmissions.
8. A computing-device implemented method for identifying and
treating restrictive and obstructive lung disease or
cardiopulmonary disorders from a remote location; performing
non-contact monitoring of a subject to detect respiratory motion;
generating programmatically a waveform based on the detected
respiratory motion; calculating programmatically an
inspiratory:expiratory (I:E) ratio from the generated waveform;
comparing programmatically the generated waveform to a stored
waveform indicative of restrictive and obstructive lung disease or
cardiopulmonary disorders to identify whether the monitored subject
is afflicted with restrictive and obstructive lung disease or
cardiopulmonary disorders, and displaying the calculated I:E ratio
and a result of the comparing to a remotely located clinician.
9. The method of claim 8 wherein the comparing uses a previous
breathing waveform, or personalized data concerning an occupation
or physical condition of the subject.
10. The method of claim 8 in which the I:E ratio is calculated as a
quotient of a duration of time that a target surface is moving away
from a sensor and a duration of time the target is moving towards
the sensor.
11. The method of claim 8 wherein the non-contact monitoring
monitors the subject using radiated energy.
12. The method of claim 11 wherein the non-contact monitoring
monitors the subject using one of ultrasound, laser detection,
infrared or radio frequency transmissions.
13. The method of claim 8 wherein the non-contact monitoring
detects a phase difference by measuring a change in the position of
the abdomen and thorax.
14. A non-transitory computer-readable medium holding
computer-executable instructions for identifying and treating
restrictive and obstructive lung disease or cardiopulmonary
disorders from a remote location, the instructions when executed
causing at least one computing device to: perform non-contact
monitoring of a subject to detect respiratory motion; generate
programmatically a waveform based on the detected respiratory
motion; calculate programmatically an inspiratory:expiratory (I:E)
ratio from the generated waveform; compare programmatically the
generated waveform to a stored waveform indicative of restrictive
and obstructive lung disease or cardiopulmonary disorders to
identify whether the monitored subject is afflicted with
restrictive and obstructive lung disease or cardiopulmonary
disorders, and display the calculated I:E ratio and a result of the
comparing to a remotely located clinician.
15. The medium of claim 14 wherein the comparing uses a previous
breathing waveform captured during a previous monitoring of the
subject, or personalized data concerning an occupation or physical
condition of the subject.
16. The medium of claim 14 in which the I:E ratio is calculated as
a quotient of a duration of time that a target surface is moving
away from a sensor and a duration of time the target is moving
towards the sensor.
17. The medium of claim 14 wherein the non-contact monitoring
monitors the subject using radiated energy.
18. The medium of claim 17 wherein the non-contact monitoring
monitors the subject using one of ultrasound, laser detection,
infrared or radio frequency transmissions.
19. The medium of claim 14 wherein the non-contact monitoring
detects a phase difference by measuring a change in the position of
the abdomen and thorax.
20. A method for identifying and treating lung or cardiopulmonary
disorders from a remote location, comprising: performing
non-contact monitoring of a subject to detect respiratory motion of
the subject; generating programmatically a waveform based on the
detected respiratory motion; analyzing programmatically the
generated waveform to identify or monitor lung or cardiopulmonary
disorders; and programmatically transmitting an order to dispense
medication to the subject based on the analyzing.
Description
RELATED APPLICATION
[0001] The present application is related to and claims the benefit
of U.S. Provisional Patent Application No. 61/320,561, filed Apr.
2, 2010, entitled "System and Method for Remotely Diagnosing and
Managing Treatment of Restrictive and Obstructive Lung Disease and
Cardiopulmonary Disorders. The present application is also a
continuation-in-part of U.S. application Ser. No. 11/308,675, filed
Apr. 20, 2006, and entitled "Method for Using a Non-Invasive
Cardiac and Respiratory Monitoring System." The contents of both
applications are incorporated herein by reference in their
entirety.
BACKGROUND
[0002] Telemedicine technologies are useful tools for the treatment
and monitoring of chronic obstructive pulmonary disease (COPD) and
reactive airway diseases (RAD) such as asthma. For example,
according to a study by researchers at the Veterans
Administration's Medical Center (VAMC) in Milwaukee, patients
believed to have COPD typically experience a 2 or 3-day process as
they travel to VAMC and undergo diagnosis. In addition, some of the
patients who made the long journey ultimately did not have the
disease. In contrast, VAMC efforts to use a respiratory therapist
or registered nurse at a remote site with patients staying closer
to home have proven very successful. In ninety percent of VAMC
cases, doctors reached a final diagnosis after the first
consultation. Telemedicine also resulted in significant changes in
medication, diagnostic procedures or lifestyle for many of the
patients in the study. Notably, the use of telemedicine saved 684
patient visits during the seven year study period and more than
294,000 miles of travel and 748 work days.
BRIEF SUMMARY OF THE INVENTION
[0003] The embodiments of the present invention provide a mechanism
for remote non-contact monitoring of physiologic (e.g.: respiratory
and cardiac) functions that may be used to diagnose and monitor
restrictive and obstructive lung disease including pneumonia, COPD
and reactive airway diseases such as asthma and croup, and
cardiopulmonary disorders that impact on the respiratory system,
such as congestive heart disease. Respiratory waveforms are
generated based on the monitored physiologic functions. Inspiratory
to expiratory (I:E) ratios which are an important tool in
determining the presence or absence of restrictive and obstructive
lung disease are determined from the waveform and displayed.
Analysis can be performed at the monitoring site or the gathered
waveform may be transmitted to a location remote from the
monitoring site for analysis. The generated waveforms and ratios
may be analyzed and compared to a target waveform for the disease
to help identify whether the subject has restrictive or obstructive
lung disease and/or determine the current status of the
individual.
[0004] Comparison to a patient's own waveform over time may also
form part of the analysis and treatment process. For example, a
patient may be monitored in the morning to establish a baseline
waveform, use a bronchodilator or undergo other treatment, and then
be monitored to capture a second waveform. The response to therapy
for that individual (comparing an earlier to later waveform) will
help a clinician determine if therapy should be altered or
maintained or if the patient needs to come in and be re-evaluated
in-person by a clinician.
[0005] In one embodiment, a monitoring and analysis system for
identifying and treating restrictive and obstructive lung disease
or cardiopulmonary disorders from a remote location includes a
respiratory waveform detection module. The respiratory waveform
detection module performs non-contact monitoring of a subject to
detect respiratory motion and generates a waveform based on the
detected respiratory motion. The system also includes an analysis
module programmatically analyzing the generated waveform to
identify restrictive and obstructive lung disease or
cardiopulmonary disorders in the monitored subject. The analyzing
process also calculates an inspiratory:expiratory (I:E) ratio from
the generated waveform and compares the generated waveform to a
stored waveform indicative of restrictive and obstructive lung
disease or cardiopulmonary disorders. A result of the comparison
and the I:E ratio is displayed to a remotely located clinician for
further analysis.
[0006] In another embodiment, a computing-device implemented method
for identifying and treating restrictive and obstructive lung
disease or cardiopulmonary disorders from a remote location
includes the performing of non-contact monitoring of a subject to
detect respiratory motion. The method also generates
programmatically a waveform based on the detected respiratory
motion and calculates programmatically an inspiratory:expiratory
(I:E) ratio from the generated waveform. The generated waveform is
programmatically compared to a stored waveform indicative of
restrictive and obstructive lung disease or cardiopulmonary
disorders to identify whether the monitored subject is afflicted
with restrictive and obstructive lung disease or cardiopulmonary
disorders. The method also displays the calculated I:E ratio and a
result of the comparing to a remotely located clinician for further
analysis.
[0007] In an embodiment, a method for identifying and treating lung
or cardiopulmonary disorders from a remote location includes
performing non-contact monitoring of a subject to detect
respiratory motion of a subject. The method also generates
programmatically a waveform based on the detected respiratory
motion and analyzes programmatically the generated waveform to
identify or monitor lung or cardiopulmonary disorders. Based on the
analyzing, an order is programmatically transmitted to dispense
medication to the subject.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] The accompanying drawings, which are incorporated in and
constitute a part of this specification, illustrate one or more
embodiments of the invention and, together with the description,
help to explain the invention. In the drawings:
[0009] FIG. 1 depicts an exemplary environment suitable for
practicing embodiments of the present invention;
[0010] FIG. 2 depicts an exemplary integrated monitoring
apparatus;
[0011] FIG. 3 depicts an exemplary sequence of steps performed by
an embodiment of the present invention to identify and/or monitor
individuals with restrictive and obstructive lung disease or
cardiopulmonary disorders;
[0012] FIG. 4 depicts user-customizable music and image settings on
a smartphone; and
[0013] FIGS. 5A-5C depict exemplary aroma dispensing modules.
DETAILED DESCRIPTION
[0014] The embodiments of the present invention utilize a
non-contact monitoring system to remotely monitor physiologic
functions of a monitored subject. The functions are analyzed to
diagnose the presence and/or status of restrictive and obstructive
lung disease or cardiopulmonary disorders in a monitored subject.
Non-contact measurement of breathing parameters (e.g.: rate, rhythm
amplitude, pauses, inspiratory to expiratory ratio, breathing
frequency variability) and/or body movements are used in the
diagnostic process. Feedback can be provided to the monitored
subject in real-time from doctors in remote locations and
treatments and therapies may be adjusted as needed.
[0015] FIG. 1 depicts an exemplary environment suitable for
practicing embodiments of the present invention. Monitoring system
10 may include monitoring apparatus 100 that is used to monitor
physiological factors for a monitored subject 120. Monitoring
apparatus 100 may include a respiratory waveform detection module
102. Respiratory waveform detection module 102 is used to perform
non-contact respiratory monitoring of monitored subject 102 and to
generate a waveform representing the monitored respiratory process.
A number of different techniques to perform the non-contact
monitoring may be used and are described in greater detail
below.
[0016] In order to get the subject into a relaxed state for
monitoring, the monitoring system may include biofeedback module
106. Biofeedback module 106 may provide alternative sensory
feedback designed to create an environment conducive to achieving
or maintaining a desired respiratory status (for example to calm
down a subject during an asthmatic event or prevent the onset of
the event or to allow for easier monitoring). For example,
biofeedback module 106 may provide visible displays, audible
feedback such as music via audio module 140, or aromatic feedback
via aroma dispensing module 144, that is designed to assist the
monitored subject in achieving a desired breathing status. In one
embodiment, the biofeedback may occur in the form of a voice giving
algorithm-based guidance to a subject to attempt to lead the
subject in a breathing exercise in order to bring the subject's
breathing closer to a desired respiration rate and thereby achieve
a target waveform. By utilizing voice-based instruction, the
subject may perform the breathing exercise with his or her eyes
closed and avoid visual distractions that might otherwise be
present.
[0017] Once a waveform representing the monitored respiratory
function has been generated, monitoring system 10 analyzes the
generated waveform to determine whether the current monitored
physiologic process is indicative of restrictive and obstructive
lung disease or cardiopulmonary disorders. In one embodiment, the
generated waveform is programmatically analyzed by a software
analysis module 132 executing on a computing device 130. Computing
device 130 may take many forms, including but not limited to a
personal computer, workstation, server, network computer, quantum
computer, optical computer, bio computer, Internet appliance,
mobile phones and other mobile devices such as smartphones, a
pager, a tablet computing device, or other form of computing device
equipped with a processor and able to execute analysis module 132.
Computing device 130 may be electronic and may include a Central
Processing Unit (CPU), memory, storage, input control, modem,
network interface, etc. The CPU may control each component of
computing device 130 to provide an environment suitable for
executing analysis module 132. The memory on computing device 130
temporarily stores instructions and data and provides them to the
CPU so that the CPU operates the computing device 130.
[0018] Optionally, computing device 130 may include multiple CPUs
for executing software loaded in memory and other programs for
controlling system hardware. Each of the CPUs can be a single or a
multiple core processor. The code loaded in the memory may run in a
virtualized environment, such as in a Virtual Machine (VM).
Multiple VMs may be resident on a single processor. Also, part of
the code may be run in hardware, for example, by configuring a
field programmable gate array (FPGA), using an application specific
instruction set processor (ASIP) or creating an application
specific integrated circuit (ASIC).
[0019] Input control for the computing device 130 may interface
with a keyboard, mouse, microphone, camera, such as a web camera,
or other input devices such as a 3D mouse, space mouse, multipoint
touchpad, accelerometer-based device, gyroscope-based device, etc.
Computing device 130 may receive, through the input control, input
data 136 relevant for calculating target waveforms for monitored
subject 120. Optionally, computing device 130 may display data
relevant to the generated waveform on a display as part of the
analysis process.
[0020] In one embodiment, monitoring apparatus 100 communicates
with computing device 130 over a network 110. Network 110 may be
the Internet, an intranet, LAN (Local Area Network), WAN (Wide Area
Network), MAN (Metropolitan Area Network), wireless network or some
other type of network over which monitoring apparatus 100 and
computing device 130 can communicate. Although depicted as a
separate device in FIG. 1, it should also be appreciated that
computing device 130 may also be part of an integrated apparatus
with monitoring apparatus 100.
[0021] Analysis module 132 analyzes the generated waveform produced
by monitoring apparatus 100. The generated waveform is compared
against stored waveform patterns 134 to determine whether the
current generated waveform is indicative of restrictive and
obstructive lung disease or cardiopulmonary disorders. The
selection of the comparison waveform from the stored waveform
patterns may utilize previous input data 136 that includes
information regarding the monitored subject such as a previously
stored base-line breathing waveform, personal medical information
(e.g. sex, height, weight, age, family history of various diseases,
etc. and occupational information). The information may be
subject-specific or based on the subject's personal or occupational
demographic. Based on available data, the analysis module 132
selects either a previously stored base-line breathing waveform, a
customized target waveform or a default waveform for comparison to
the generated waveform. For example, in one embodiment, the subject
may be monitored to establish a baseline waveform prior to
undergoing a particular treatment modality. Subsequent waveforms
may then be compared to the baseline waveform to determine
treatment effectiveness. In another embodiment, the stored
waveforms are those of other individuals previously diagnosed as
having a restrictive and obstructive lung disease or
cardiopulmonary disorder.
[0022] In one embodiment, the analysis of the generated waveform
may be a programmatic process that occurs in an automated fashion.
In an alternate embodiment, the process may also involve human
input in reviewing the selection of the target waveform and
interpreting the result of the comparison prior to completion of
the analysis. In one embodiment, all of the analysis decisions are
saved for future study in order to continually refine the stored
waveform patterns 134. It should be noted that the analysis module
132 may be located on the local monitoring device or "off-site" at
a remote location.
[0023] The results of the analysis performed by the analysis module
132 may be provided to one or more remotely located clinicians. In
addition to displaying the captured breathing waveform, the
analysis module 132 may also calculate an inspiratory/expiratory
(I:E) ratio from the captured waveform and display it to the
clinician and/or overlay the display of the captured waveform with
the comparison waveform for review. It should be appreciated that
in some embodiments, the functionality attributed to the analysis
module 132 and the respiratory waveform detection module 102 may be
split into additional modules or combined into one module without
departing from the scope of the present invention.
[0024] Following the analysis of the generated waveform, the
clinician may take a number of actions. The clinician may do
nothing and continue to monitor the subject. Alternatively, the
output of the analysis module may help the clinician reach an
initial diagnosis as to whether or not the monitored subject has
restrictive and obstructive lung disease or cardiopulmonary
disorders. Additionally, the output of the analysis module may
indicate to the clinician that a monitored subject who has
previously been diagnosed with restrictive and obstructive lung
disease or cardiopulmonary disorders has undergone a change in
condition with the result that the clinician prescribes different
treatment and/or medicines for the monitored subject. The
embodiments of the present invention thus allow real-time
monitoring and treatment of individuals with restrictive and
obstructive lung disease or cardiopulmonary disorders from a remote
location.
[0025] In one embodiment, the non-contact monitoring system may
also be configured to measure "phase difference". Phase difference
measures changes in the abdomen and thorax that occur during
breathing that are a sign of breathing disorders including asthma.
The synchrony or asynchrony between chest and abdomen during
breathing has wide diagnostic and therapeutic implications for
respiratory disease, sleep disturbances, recovery from anesthesia
and may provide predictive and biofeedback information for
relaxation and stress reduction techniques. Such measurements may
be used to monitor response to treatment from a remote location.
The measured data would be objective (as opposed to the clinician
simply observing as in the present standard-of-care) and could be
stored and made a part of the monitored subject's chart for future
reference.
[0026] The non-contact monitoring system may use radiated energy
(e.g.: ultrasonic, radio frequency, infrared, laser, etc.) to
identify respiratory waveforms in patients. The monitoring system
may illuminate a subject in radiated energy and then detect the
reflected radiated energy caused by respiratory functions. Of note,
the breathing waveform can be captured through clothes and does not
need a specific window to receive the necessary information to
generate a breathing waveform. However, in one embodiment, a signal
enhancer 122 may be utilized to augment the reflected signal. This
may be in the form of a "relaxation patch" worn by the participant.
The detected reflections are used to plot a two-dimensional
waveform. The waveforms represent the rise and fall of a detected
signal (the reflected energy) over time and are indicative of the
small movements of the patient's chest, abdomen and/or other
anatomical sites that are associated with respiratory function.
Different implementations of the monitoring system use different
forms of radiated energy (e.g.: laser, ultrasonic energy and radio
frequency) to capture breathing waveforms for analysis.
[0027] One example of a suitable non-contact monitoring system that
may be leveraged in conjunction with the embodiments of the present
invention is described in U.S. Pat. No. 6,062,216 ('216 patent). As
described in the '216 patent, a respiratory monitor may employ
either ultrasonic or laser monitoring of an individual's breathing
function by measuring changes in body position with respect to
time. The device continuously and without the need for contact,
monitors the individual's breathing function (and analyzes the
measured waveform and identifies respiratory rate, apneic pauses,
and obstructive breathing) and body movements. The '216 patent (the
contents of which are hereby incorporated by reference) describes a
monitoring system using laser energy or ultrasonic energy to
monitor respiratory function so as to detect sleep apnea but may be
adapted to perform the respiratory monitoring described herein. It
should be appreciated that although the monitoring system of the
'216 patent has been cited as an exemplary monitoring system which
may be used in the present invention, other non-invasive monitoring
systems utilizing laser or ultrasonic energy to detect respiratory
waveforms may also be used within the scope of the present
invention.
[0028] In one embodiment, the respiratory waveform detection module
102 may use ultrasound to perform the physiological monitoring to
establish the waveforms used in the present invention. Ultrasonic
sound is a vibration at a frequency above the range of human
hearing, in other words usually in a range above 20 kHz. In one
embodiment, a shaped transducer in the monitoring system radiates a
preferably continuous beam of ultrasound for example in the 25 kHz
to 500 kHz range to illuminate a subject patient. A receiving
transducer in the monitoring system of the present invention or
transducer array develops one or more signals, which shift slightly
from the incident frequency due to respiratory motion. The signal
is then analyzed and plotted to generate a waveform, which may be
compared against an appropriate benchmark. Appropriate adjustments
are made by the monitoring system to account for the distance
between the monitoring system and the subject as well as any
environmental factors affecting the detection of the reflected
energy.
[0029] In another embodiment, the monitoring system may use laser
detection means as described in the '216 patent in place of
ultrasonic energy. In such a case a laser illuminates the subject
patient in a beam of light of a selected wavelength and the
reflected energy, which varies based on respiratory movements is
traced so as to generate a waveform. Additionally, other
embodiments utilizing infrared, radio frequency or other wavelength
ranges in the electromagnetic spectrum may be employed in order to
perform the non-contact monitoring and analysis of respiratory
functions described herein.
[0030] In one embodiment, the monitoring system described herein
may be provided as an integrated monitoring apparatus rather than
as separate components in multiple devices. FIG. 2 depicts an
exemplary integrated monitoring apparatus 200 that includes most or
all of the components of the monitoring system described in FIG. 1.
The integrated monitoring apparatus 200 may include one or more
waveform detection modules 210 such as respiratory waveform
detection modules. The integrated monitoring apparatus 200 may also
include biofeedback module 220 and analysis module 230. Analysis
module 230 may include stored waveform patterns 232 and stored
input data 234 specific to a monitored subject. It will be
appreciated that the waveform detection module 210, biofeedback
module 220 and analysis module 230 may be combined into a single
module or split into additional modules without departing from the
scope of the present invention.
[0031] In one embodiment, integrated monitoring apparatus 200 may
also include an aroma dispensing module 240 and an audio module 250
for providing aromatic and audio feedback and an integrated display
module 260 utilized to provide visual feedback to a monitored
subject in the manner described herein. In other embodiments,
integrated monitoring apparatus 200 may contain some but not all of
the modules 240, 250 and 260 used to provide feedback and
biofeedback. The aroma dispensing module 240 may include one or
more stored scents that are designed to be soothing when inhaled
and that are released into the monitored subject's environment at
different times and in different amounts upon a signal being
received from the biofeedback module 206. In an additional aspect
of an embodiment of the present invention, the tactile, audible,
visual and aromatic feedback may be dispensed as an adjunct to
monitoring to prepare the subject for monitoring by creating a
proper mood for monitoring prior to, or in addition to, any
monitoring-based biofeedback being delivered.
[0032] In one exemplary embodiment, the integrated monitoring
apparatus 200 may be provided via a portable device such as a
mobile phone or smartphone, tablet computing device or laptop. For
example, the mobile phone or smartphone, tablet computing device or
laptop may be equipped with an ultrasound probe that is part of the
device or connected via BLUETOOTH, or connected via a USB or other
interface and that that is used to perform ultrasound monitoring.
The detection and/or analysis modules described herein may be
pre-installed or downloaded to the device. In one embodiment,
portable devices such as a mobile phone or smartphone, tablet
computing device or laptop display and speakers may be used to
provide visual, audio and/or tactile feedback.
[0033] FIG. 3 depicts an exemplary sequence of steps performed by
an embodiment of the present invention to identify or monitor
restrictive and obstructive lung disease or cardiopulmonary
disorders in a monitored subject. The sequence may begin by
providing non-contact monitoring of a subject as described herein
to detect respiratory motion (step 300). Of note, the subject may
or may not be aware of the monitoring. In one embodiment, the
subject is informed of the beginning of the monitoring. The subject
in such a case may attempt to perform breathing exercises to enter
a relaxed state. In another embodiment, background monitoring may
be conducted as part of a normal background process. For example,
the monitoring could be performed continually at work.
[0034] After data is gathered, a waveform is generated as a result
of the monitoring process (step 302). The waveform is analyzed by
the analysis module to identify whether the subject being monitored
has restrictive and obstructive lung disease or cardiopulmonary
disorders or whether their condition has changed (step 304). The
analysis may include the generation of an I:E ratio from the
generated waveform. The analysis is provided to a clinician for
further examination (step 306). Optionally, the clinician can then
contact the subject to inform the subject in real-time of the
results. In one embodiment, a patient may provide a sample
breathing waveform, then receive treatment such as using a
bronchodilator, and then send another waveform for analysis. The
analysis may compare the later waveform to the earlier waveform to
determine if therapy should be increased, stay the same, be
decreased, changed or if a patient needs to be seen in person.
[0035] As noted above, the embodiments of the present invention may
be used to determine I:E ratios for a monitored subject. In one
embodiment, the I:E ratio is calculated as the quotient of the
duration of time that the target surface is moving away from the
sensor (assumed to be expiration) and the duration of time the
target is moving towards the sensor (assumed to be inspiration).
Inspiration and expiration durations are monitored over several
full breathing cycles so that the resulting measurement is an
average. The ratio is displayed on the screen whenever a sufficient
number of full breathing waveforms that pass a simple quality
screen have been counted. The ratio is displayed as "1:X"--where X
is the calculated quotient, in one embodiment rounded to the
nearest 0.25.
[0036] For example, in one embodiment designed to run on an IPHONE
acting as a monitoring device as described herein, the
sample-by-sample processing of the filtered ultrasound signal (out)
and the calculated output suppression variable (sup) that are
currently being used in the IPHONE code (which may be written in
MATLAB, a programming language and environment provided by The
MathWorks, Inc. of Natick, Mass.) may be expressed as:
[0037] For each sample of the displayed breathing waveform,
utilizing the current and previous value of the out signal and the
current value of the sup variable, do the following:
TABLE-US-00001 - if sup flag is on (output to be suppressed) then -
clear all counters and variables - goto next sample - else -
increment curdur. - compare current and prior out samples to
determine if current sample is inspiratory (>= prior out) or
expiratory (< prior out). - if current sample is inspiratory,
then - increment curindur. - if ( lastie was expiratory ) AND ( out
<= -transthresh ) , then - if ( durthresh1 <= curdur <=
durthresh2 ), then - increment goodcyc. - copy curindur and
curexdur to head position of indurvec and exdurvec respectively. -
clear curdur, curindur, and curexdur. - if goodcyc >= numcyc,
then - calculate raw I:E as ierat = sum(exdurvec)/sum(indurvec). -
round ierat to nearest 0.25. - else - clear all counters and
variables - goto next sample - set lastie to inspiratory (+1). -
else - increment curexdur. - set lastie to expiratory (-1). where:
numcyc - number of quality full breath cycles required to enable
calculation and display of ratio. transthresh - threshold amplitude
required to classify a point as a transition from insp. to exp.
durthresh1 - minimum duration of full breath cycle to include in
I:E ratio calculation. durthresh2 - maximum duration of full breath
cycle to include in I:E ratio calculation. lastie - flag indicating
whether the last sample point was insp.(+1), exp.(- 1), or undef
(0). curdur - duration of current breath cycle. curindur - count of
the number of samples classified as inspiration in current breath.
curexdur - count of the number of samples classified as expiration
in current breath. indurvec - length numcyc circular buffer of
inspiration durations. exdurvec - length numcyc circular buffer of
inspiration durations. goodcyc - counter of quality full breathing
cycles. ierat - calculated I:E ratio. Value of zero indicates that
ratio should not be displayed.
[0038] It should be noted that although much of the discussion
herein has focused on lung disorders, other disorders, such as
congestive heart disease (cardiopulmonary), which will affect
breathing (impacting respiratory rate, amplitude, I:E ratio, and
breathing rate variability) and other diseases that indirectly
impact respiration may be monitored using the embodiments of the
present invention.
[0039] As noted above, embodiments of the present invention include
components to assist in relaxing a subject for monitoring.
Accordingly, in another aspect of the present invention, the system
is also well suited to apply known therapies for relaxation and
stress reduction. That is, getting the participant to reduce his or
her breathing rate can be coupled with tactile, visual, aromatic or
auditory cues to relax the subject. Visual, aromatic, audible and
tactile feedback may be delivered to the subject with or without a
waveform being displayed. Music or visual images can be displayed
in response to both positive and negative physiologic responses on
the system. In one embodiment, the form of the music, visual images
or other biofeedback being presented to a user may be customizable
by the user. For example, in one embodiment, the user may adjust
settings on a mobile phone being utilized as the integrated
monitoring apparatus of the present invention. For example, as
depicted in FIG. 4, the user may select the particular audio
selections 401 or images 402 presented in a slideshow that are
generated by the phone in response to monitored physiological
responses.
[0040] In another embodiment, the tactile, visual, aromatic or
auditory cues may be delivered with or without actively monitoring
the subject and/or making the subject aware of their own breathing.
For example, the tactile, visual, aromatic or auditory cues may be
delivered to help with stress reduction or relaxation for an
individual. For instance, aromatherapy is a form of alternative
medicine that uses aromatic compounds for the purpose of improving
a person's mood, cognitive function and health. Aromatherapy has
been shown to be instrumental in enhancing stress management and
relaxation programs. In one embodiment an aromatherapy module may
be integrated with personalized stress management programs. The
module holds one or more generic or propriety essences. The release
of the relaxing essences may be initiated by apps which can be
running on desktop computers, laptops, Smartphones or tablet
computing devices such as the IPAD that are in communication with,
or integrated with, an aroma dispensing module. FIGS. 5A-5C depict
exemplary aroma dispensing modules. It will be appreciated that the
aroma dispensing module may also be functioning as the monitoring
device as described herein.
[0041] In one programmed mode, soothing and refreshing essences are
released into the user's environment a short period of time before
the user is notified that it is time to enter a relaxation exercise
or be monitored. In this manner, the user "gets-in-the-mood" and is
psychologically prepared and primed to perform the relaxation
exercise. Release of the aromatherapy can be based on monitored
biofeedback from a monitoring device performing respiratory
monitoring or simply based on personalized programming from the
user. For example, individuals in a corporate setting may prefer to
have set time periods for release of the aromatherapy, such an hour
or two into the work day, early afternoon and then again before the
evening commute. Alternatively, factory set time default periods
may also be employed. From a consumer point-of-view, personalizing
and automating the experience lead to increased compliance and
well-being with relaxation, stress management, exercise and
training regimens. From a corporate point-of-view, the user gets
the benefits of the proprietary aromatherapy while ensuring regular
and sustained use of the products.
[0042] As noted above, the monitored information and analysis
decisions may be stored. The ability to store the monitored
information allows an objective response to therapy, provides
storage for medical records and is of importance for third party
reimbursement. Further, having objective and permanent records of
responses to therapy adds to the attractiveness of the technique to
clinicians and leads to better compliance with a therapeutic or
relaxation regime from subjects being monitored.
[0043] It should be understood that other physiologic parameters,
(video, audio, etc) could be incorporated to add robustness to the
proposed system. Further, though breathing and body movement are
optimally derived through non-contact means to prevent the creation
of an overly artificial environment, a contact monitoring system
may also be used to perform monitoring of a subject.
[0044] In one embodiment, the non-contact monitoring system of the
present invention may be used to diagnose and treat restrictive and
obstructive lung disease and cardiopulmonary disorders in pediatric
patients. For example, the monitoring system may be employed on a
tablet computing device or smartphone on which an instructional
cartoon or educational game is displayed in order to capture a
child's attention and increase the likelihood of compliance and
successful completion. During the display of the cartoon or
educational game the child's breathing waveform may be captured,
analyzed and transmitted (or transmitted and then analyzed
depending on implementation of the monitoring and analysis system
described herein).
[0045] In some embodiments, the monitoring and/or analysis modules
may be deployed to the monitoring device as downloadable applets.
For example, in one implementation, the monitoring and/or analysis
modules may be downloaded to a smartphone or tablet computing
device from a third party vendor, such as via the Apple iTunes.RTM.
website.
[0046] In one embodiment, after the process of capturing the
waveform and analyzing the waveform, medication is dispensed to the
patient (dose, type, frequency) based on either a clinician reading
the waveform or an automatic computer reading of the waveform. The
dispensing of medication may occur manually or may occur through
the transmission of an electronic signal to a dispensing apparatus
proximally located near the monitored subject. For example, a
signal might be sent to an IV unit equipped with medication
connected to the monitored subject.
[0047] The present invention may be provided as one or more
computer-readable programs embodied on or in one or more
non-transitory physical mediums. The mediums may be a floppy disk,
a hard disk, a compact disc, a digital versatile disc, a flash
memory card, a PROM, an MRAM, a RAM, a ROM, or a magnetic tape. In
general, the computer-readable programs may be implemented in any
programming language. Some examples of languages that can be used
include C, C++, C#, Python, FLASH, JavaScript, or Java. The
software programs may be stored on, or in, one or more mediums as
object code. Hardware acceleration may be used and all or a portion
of the code may run on a FPGA, an Application Specific Integrated
Processor (ASIP), or an Application Specific Integrated Circuit
(ASIC). The code may run in a virtualized environment such as in a
virtual machine. Multiple virtual machines running the code may be
resident on a single processor.
[0048] Since certain changes may be made without departing from the
scope of the present invention, it is intended that all matter
contained in the above description or shown in the accompanying
drawings be interpreted as illustrative and not in a literal sense.
Practitioners of the art will realize that the sequence of steps
and architectures depicted in the figures may be altered without
departing from the scope of the present invention and that the
illustrations contained herein are singular examples of a multitude
of possible depictions of the present invention.
[0049] The foregoing description of example embodiments of the
invention provides illustration and description, but is not
intended to be exhaustive or to limit the invention to the precise
form disclosed. Modifications and variations are possible in light
of the above teachings or may be acquired from practice of the
invention. For example, while a series of acts has been described,
the order of the acts may be modified in other implementations
consistent with the principles of the invention. Further,
non-dependent acts may be performed in parallel.
[0050] In addition, implementations consistent with principles of
the invention can be implemented using devices and configurations
other than those illustrated in the figures and described in the
specification without departing from the spirit of the invention.
Devices and/or components may be added and/or removed from the
specifically disclosed implementations depending on specific
deployments and/or applications.
* * * * *